Download PDF
J Pediatr Intensive Care 2015; 04(03): 146-155
DOI: 10.1055/s-0035-1559824
Original Article
Georg Thieme Verlag KG Stuttgart · New York

Factors Associated with Survival during High-Frequency Oscillatory Ventilation in Children

Shekhar S. Raj
1   Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
,
James E. Slaven
2   Department of Biostatistics, Indiana University School of Medicine, Indianapolis, Indiana, United States
,
Mark R. Rigby
1   Pediatric Critical Care Medicine, Department of Pediatrics, Indiana University School of Medicine and Riley Hospital for Children at Indiana University Health, Indianapolis, Indiana, United States
› Author Affiliations
Further Information

Publication History

10 July 2014

27 July 2014

Publication Date:
12 August 2015 (online)

    Permissions and Reprints

Abstract

Our aim is to determine indicators of survival in children with severe hypoxic respiratory failure (HRF) after transition to high-frequency oscillatory ventilation (HFOV). Single-center retrospective examination of children with HRF transitioned to HFOV. Blood gases and ventilator settings 24 hours prior to and 48 hours after HFOV in survivors and nonsurvivors were evaluated. Sixty-two children with mean age of 7 years and mean weight of 26 kg were included with an observed mortality of 29%. Mean airway pressures (Paw), oxygenation index (OI), arterial oxygen partial pressure (PaO2)/fraction of inspired oxygen (FiO2) (P/F) ratio, pH, bicarbonate, and arterial carbon dioxide partial pressure were similar prior to HFOV in survivors and nonsurvivors. During HFOV, mean OI and P/F ratio improved in both groups with an average Paw increase of ∼10 cm H2O. Survivors had lower OI than nonsurvivors (21 ± 0.9 vs. 26.5 ± 2.2; p < 0.01) beginning 24 hours after HFOV. P/F ratio appears to diverge by 36 hours, with survivors having P/F ratio >200. Survivors had higher pH than nonsurvivors at 36 hours (7.40 ± 0.01 vs. 7.32 ± 0.02; p < 0.05), higher bicarbonate levels (27.1 ± 0.7 vs. 23.9 ± 1.3 mEq/L), and similar arterial carbon dioxide partial pressure with less oscillatory support (i.e., hertz and amplitude). Inhaled nitric oxide was used in 53% of patients with improvements in oxygenation but with no effect on mortality. HFOV improves oxygenation in children with severe HRF. Nonsurvivors can be distinguished from survivors at 24 to 36 hours during HFOV by higher OI, metabolic acidosis, and higher oscillatory support. These data may assist in prognostication or timing of initiating alternative therapies, such as extracorporeal membrane oxygenation.

Keywords

high-frequency oscillatory ventilation - mechanical ventilation - pediatric critical care - hypoxic respiratory failure - oxygenation index - nitric oxide - acute respiratory distress syndrome
 

  • References

  • 1 Kneyber MC, van Heerde M, Markhorst DG. Reflections on pediatric high-frequency oscillatory ventilation from a physiologic perspective. Respir Care 2012; 57 (9) 1496-1504
    CrossrefPubMedGoogle Scholar
  • 2 Sud S, Sud M, Friedrich JO , et al. High-frequency ventilation versus conventional ventilation for treatment of acute lung injury and acute respiratory distress syndrome. Cochrane Database Syst Rev 2013; 2: CD004085
    PubMedGoogle Scholar
  • 3 The Acute Respiratory Distress Syndrome Network. Ventilation with lower tidal volumes as compared with traditional tidal volumes for acute lung injury and the acute respiratory distress syndrome. N Engl J Med 2000; 342 (18) 1301-1308
    CrossrefPubMedGoogle Scholar
  • 4 Pierrakos C, Karanikolas M, Scolletta S, Karamouzos V, Velissaris D. Acute respiratory distress syndrome: pathophysiology and therapeutic options. J Clin Med Res 2012; 4 (1) 7-16
    PubMedGoogle Scholar
  • 5 Henderson-Smart DJ, De Paoli AG, Clark RH, Bhuta T. High frequency oscillatory ventilation versus conventional ventilation for infants with severe pulmonary dysfunction born at or near term. Cochrane Database Syst Rev 2009; (3) CD002974
    PubMedGoogle Scholar
  • 6 Cools F, Askie LM, Offringa M , et al; PreVILIG Collaboration. Elective high-frequency oscillatory versus conventional ventilation in preterm infants: a systematic review and meta-analysis of individual patients' data. Lancet 2010; 375 (9731) 2082-2091 [Review Erratum in: Lancet 2011;377(9777):1572]
    CrossrefPubMedGoogle Scholar
  • 7 Derdak S, Mehta S, Stewart TE , et al; Multicenter Oscillatory Ventilation For Acute Respiratory Distress Syndrome Trial (MOAT) Study Investigators. High-frequency oscillatory ventilation for acute respiratory distress syndrome in adults: a randomized, controlled trial. Am J Respir Crit Care Med 2002; 166 (6) 801-808
    CrossrefPubMedGoogle Scholar
  • 8 Ferguson ND, Cook DJ, Guyatt GH , et al; OSCILLATE Trial Investigators; Canadian Critical Care Trials Group. High-frequency oscillation in early acute respiratory distress syndrome. N Engl J Med 2013; 368 (9) 795-805
    CrossrefPubMedGoogle Scholar
  • 9 Arnold JH, Hanson JH, Toro-Figuero LO, Gutiérrez J, Berens RJ, Anglin DL. Prospective, randomized comparison of high-frequency oscillatory ventilation and conventional mechanical ventilation in pediatric respiratory failure. Crit Care Med 1994; 22 (10) 1530-1539
    PubMedGoogle Scholar
  • 10 Samransamruajkit R, Prapphal N, Deelodegenavong J, Poovorawan Y. Plasma soluble intercellular adhesion molecule-1 (sICAM-1) in pediatric ARDS during high frequency oscillatory ventilation: a predictor of mortality. Asian Pac J Allergy Immunol 2005; 23 (4) 181-188
    PubMedGoogle Scholar
  • 11 Santschi M, Jouvet P, Leclerc F , et al; PALIVE Investigators; Pediatric Acute Lung Injury and Sepsis Investigators Network (PALISI); European Society of Pediatric and Neonatal Intensive Care (ESPNIC). Acute lung injury in children: therapeutic practice and feasibility of international clinical trials. Pediatr Crit Care Med 2010; 11 (6) 681-689
    CrossrefPubMedGoogle Scholar
  • 12 Randolph AG, Meert KL, O'Neil ME , et al; Pediatric Acute Lung Injury and Sepsis Investigators Network. The feasibility of conducting clinical trials in infants and children with acute respiratory failure. Am J Respir Crit Care Med 2003; 167 (10) 1334-1340
    CrossrefPubMedGoogle Scholar
  • 13 Fedora M, Klimovic M, Seda M, Dominik P, Nekvasil R. Effect of early intervention of high-frequency oscillatory ventilation on the outcome in pediatric acute respiratory distress syndrome. Bratisl Lek Listy (Tlacene Vyd) 2000; 101 (1) 8-13
    PubMedGoogle Scholar
  • 14 Babbitt CJ, Cooper MC, Nussbaum E, Liao E, Levine GK, Randhawa IS. High-frequency oscillatory ventilation in pediatric acute hypoxemic respiratory failure: disease-specific morbidity survival analysis. Lung 2012; 190 (6) 685-690
    CrossrefPubMedGoogle Scholar
  • 15 Moniz M, Silvestre C, Nunes P , et al. High-frequency oscillatory ventilation in children: a 10-year experience. J Pediatr (Rio J) 2013; 89 (1) 48-55
    CrossrefPubMedGoogle Scholar
  • 16 Ben Jaballah N, Mnif K, Bouziri A, Kazdaghli K, Belhadj S, Zouari B. High-frequency oscillatory ventilation in paediatric patients with acute respiratory distress syndrome—early rescue use. Eur J Pediatr 2005; 164 (1) 17-21
    CrossrefPubMedGoogle Scholar
  • 17 Dalton H, Fortenberry JD, Frenckner B, Palmer P. ECMO for pediatric respiratory failure. In: Annich GM, Lynch WR, Maclaren G, Wilson JM, Bartlett RH, , eds. ECMO: Extracorporeal Cardiopulmonary Support in Critical Care. 4th ed. Ann Arbor, MI: ELSO; 2012: 265-270
    Google Scholar
  • 18 Yehya N, Topjian AA, Thomas NJ, Friess SH. Improved oxygenation 24 hours after transition to airway pressure release ventilation or high-frequency oscillatory ventilation accurately discriminates survival in immunocompromised pediatric patients with acute respiratory distress syndrome*. Pediatr Crit Care Med 2014; 15 (4) e147-e156
    CrossrefPubMedGoogle Scholar
  • 19 Yehya N, Topjian AA, Lin R, Berg RA, Thomas NJ, Friess SH. High frequency oscillation and airway pressure release ventilation in pediatric respiratory failure. Pediatr Pulmonol 2014; 49 (7) 707-715
    Google Scholar
  • 20 Camporota L, Sherry T, Smith J, Lei K, McLuckie A, Beale R. Physiological predictors of survival during high-frequency oscillatory ventilation in adults with acute respiratory distress syndrome. Crit Care 2013; 17 (2) R40
    CrossrefPubMedGoogle Scholar
  • 21 Sarnaik AP, Meert KL, Pappas MD, Simpson PM, Lieh-Lai MW, Heidemann SM. Predicting outcome in children with severe acute respiratory failure treated with high-frequency ventilation. Crit Care Med 1996; 24 (8) 1396-1402
    Google Scholar
  • 22 Ben Jaballah N, Khaldi A, Mnif K , et al. High-frequency oscillatory ventilation in pediatric patients with acute respiratory failure. Pediatr Crit Care Med 2006; 7 (4) 362-367
    CrossrefPubMedGoogle Scholar
  • 23 Rowan CM, Hege KM, Speicher RH , et al. Oxygenation index predicts mortality in pediatric stem cell transplant recipients requiring mechanical ventilation. Pediatr Transplant 2012; 16 (6) 645-650
    CrossrefPubMedGoogle Scholar
  • 24 Rotta AT, Steinhorn DM. Is permissive hypercapnia a beneficial strategy for pediatric acute lung injury?. Respir Care Clin N Am 2006; 12 (3) 371-387
    PubMedGoogle Scholar
  • 25 Rowan CM, Nitu ME, Rigby MR. Inconsistencies in care of the pediatric hematopoietic stem cell transplant recipient with respiratory failure: opportunity for standardization and improved outcome. Pediatr Transplant 2014; 18 (2) 230-235
    CrossrefPubMedGoogle Scholar
  • 26 Santschi M, Randolph AG, Rimensberger PC, Jouvet P ; Pediatric Acute Lung Injury Mechanical Ventilation Investigators; Pediatric Acute Lung Injury and Sepsis Investigators Network; European Society of Pediatric and Neonatal Intensive Care. Mechanical ventilation strategies in children with acute lung injury: a survey on stated practice pattern. Pediatr Crit Care Med 2013; 14 (7) e332-e337
    CrossrefPubMedGoogle Scholar
  • 27 Afshari A, Brok J, Møller AM, Wetterslev J. Inhaled nitric oxide for acute respiratory distress syndrome and acute lung injury in adults and children: a systematic review with meta-analysis and trial sequential analysis. Anesth Analg 2011; 112 (6) 1411-1421
    CrossrefPubMedGoogle Scholar
  • 28 Dobyns EL, Anas NG, Fortenberry JD , et al. Interactive effects of high-frequency oscillatory ventilation and inhaled nitric oxide in acute hypoxemic respiratory failure in pediatrics. Crit Care Med 2002; 30 (11) 2425-2429
    CrossrefPubMedGoogle Scholar
  • 29 Fioretto JR, Batista KA, Carpi MF , et al. High-frequency oscillatory ventilation associated with inhaled nitric oxide compared to pressure-controlled assist/control ventilation and inhaled nitric oxide in children: randomized, non-blinded, crossover study. Pediatr Pulmonol 2011; 46 (8) 809-816
    CrossrefPubMedGoogle Scholar